HIV with non-communicable diseases in primary care in Kibera, Nairobi, Kenya: characteristics and outcomes 2010-2013

Edwards, Jeffrey K.; Bygrave, Helen; Bergh, Rafaël Van den; Kizito, Walter; Cheti, Erastus; Kosgei, Rose J.; Sobry, Agnès; Vandenbulcke, Alexandra; Vakil, Shobha; Reid, Tony

doi:10.1093/trstmh/trv038

Cited by 61 publications

(64 citation statements)

References 24 publications

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“…After screening, 20 articles met the eligibility criteria [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and were included in the analysis (figure 1). Of these, seven 17-23 articles reported incidence of T2DM in HIV-infected participants, eight 24-31 reported prevalence of T2DM in HIV-infected participants compared with uninfected controls and five 32-36 reported prevalence of T2DM in HIV-infected participants on treatment compared with untreated controls.…”

Section: Resultsmentioning

confidence: 99%

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

et al. 2017

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ObjectivesThis systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.SettingOnly studies reporting data from Africa were included.ParticipantsA systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.Main outcome measuresIncidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.ResultsOf 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively).ConclusionsMeta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.Trial registration numberPROSPERO42016038689.

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Section: Resultsmentioning

confidence: 99%

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

et al. 2017

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“…The Sphere guidelines state that people with NCDs should be stabilized clinically and that “maintenance therapy” should be the humanitarian response [ 47 ]. The ideal model of care is NCD care integrated into existing primary health care, (PHC), facilities with simplification of protocols, provision of medicines and tools and task shifting, as done in HIV/AIDS programmes [ 48 ]. An integrated, multi and interdisciplinary approach should be chosen, involving community leaders and influential persons.…”

Section: Main Textmentioning

confidence: 99%

Non-communicable diseases in humanitarian settings: ten essential questions

et al. 2017

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Non-communicable diseases (NCDs) represent the primary cause of morbidity and mortality worldwide. Specific attention needs to be given in fragile and crisis-affected contexts, where health systems have even more difficulties in addressing and managing these diseases. Humanitarian actors intervening in crisis situations increasingly include NCD management in the services they support and provide. This review aims at presenting a series of questions that humanitarian agencies could consider when addressing NCDs in humanitarian crises. They include, among others, what conditions to address and for which target population, how to ensure continuity of care, which guidelines and medications to use, and what can be done beyond classical management of NCDs.Research and evidence are lacking on how to address care effectively for NCDs in emergencies. Therefore, advocacy is needed for NCD-oriented research so as to make interventions more effective and sustainable. No government or single agency can address NCDs in humanitarian crises alone. Strong leadership and partnerships between humanitarian actors, health providers, government bodies, research and academic institutions are required. Only a coordinated multi-disciplinary and multi-stakeholder approach will achieve the required impact for affected populations.

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“…Concurrently, there is a rapid epidemiological transition occurring in LMICs, especially Sub-Saharan Africa [ 5 ], in which an increasing prevalence of Non-Communicable Diseases (NCDs) such as hypertension and diabetes are being seen, particularly in urban informal settlements [ 6 ]. Based upon current projections within Kenya, NCDs will surpass communicable diseases such as HIV as the leading cause of mortality by 2025 [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

"They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya

et al. 2016

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IntroductionThe number of people on antiretroviral therapy (ART) for the long-term management of HIV in low- and middle-income countries (LMICs) is continuing to increase, along with the prevalence of Non-Communicable Diseases (NCDs). The need to provide large volumes of HIV patients with ART has led to significant adaptations in how medication is delivered, but access to NCD care remains limited in many contexts. Medication Adherence Clubs (MACs) were established in Kibera, Kenya to address the large numbers of patients requiring chronic HIV and/or NCD care. Stable NCD and HIV patients can now collect their chronic medication every three months through a club, rather than through individual clinic appointments.MethodologyWe conducted a qualitative research study to assess patient and health-care worker perceptions and experiences of MACs in the urban informal settlement of Kibera, Kenya. A total of 106 patients (with HIV and/or other NCDs) and health-care workers were purposively sampled and included in the study. Ten focus groups and 19 in-depth interviews were conducted and 15 sessions of participant observation were carried out at the clinic where the MACs took place. Thematic data analysis was conducted using NVivo software, and coding focussed on people’s experiences of MACs, the challenges they faced and their perceptions about models of care for chronic conditions.ResultsMACs were considered acceptable to patients and health-care workers because they saved time, prevented unnecessary queues in the clinic and provided people with health education and group support whilst they collected their medication. Some patients and health-care workers felt that MACs reduced stigma for HIV positive patients by treating HIV as any other chronic condition. Staff and patients reported challenges recruiting patients into MACs, including patients not fully understanding the eligibility criteria for the clubs. There were also some practical challenges during the implementation of the clubs, but MACs have shown that it is possible to learn from ART provision and enable stable HIV and NCD patients to collect chronic medication together in a group.ConclusionsExtending models of care previously only offered to HIV-positive cohorts to NCD patients can help to de-stigmatise HIV, allow for the efficient clinical management of co-morbidities and enable patients to benefit from peer support. Through MACs, we have demonstrated that an integrated approach to providing medication for chronic diseases including HIV can be implemented in resource-poor settings and could thus be rolled out in other similar contexts.

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HIV with non-communicable diseases in primary care in Kibera, Nairobi, Kenya: characteristics and outcomes 2010-2013

Cited by 61 publications

References 24 publications

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

Non-communicable diseases in humanitarian settings: ten essential questions

"They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya

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